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Attention: The PA UCP has the new DBE No Change Annual Affidavit form available now. 337 0 obj
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Is your firm organized as a for-profit business?
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Is at least 51% of the ownership a U.S. citizen(s) or lawfully permanent resident(s) of the U.S.? "y�����Q � �O,
If you answered "Yes" to all of the questions above, you may be eligible to participate as a DBE/ACDBE/Both (DBE & ACDBE). Contact person and Title: Legal name of … For detailed information, select this link UPDATED Extended COVID-19 Guidance DBE ANNUAL AFFIDAVIT Please complete the following information, sign, notarize and return this form to your certifying agency along with your firm's most recent federal business tax return(s) for the DBE firm and any affiliate firms. A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS ANNUAL AFFIDAVIT IS SUFFICIENT CAUSE FOR REVOCATION OF A PRIOR APPROVAL, INITIATION OF SUSPENSION OR DEBARMENT endstream
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Annual Affidavit Document Checklist. AFFIDAVIT OF CERTIFICATION This form must be signed and notarized for each owner upon which disadvantaged status is relied. In order to become certified you may download the Disadvantaged Business Enterprise Certification Application or contact any of the Certifying Participants. PA UCP & Certification Supportive Material ... DBE Supportive Services. Is the applicant firm's three year average of gross receipts less than $23.98 million? For more information about the DBE Program, contact the DBE Supportive Services Center at ProRank Business Solutions, LLC by phone at 833.PENN.DBE (833.736.6323) or by email at penndbe@prorankllc.com or PennDOT's Bureau of Equal Opportunity by phone 717.787.5891 or 800.468.4201 or email at penndotucpinfo@pa.gov. Businesses located outside of Pennsylvania must first obtain DBE certification in their home state before applying for DBE certification in the PA UCP. h�b```�+��2� ��ea�x��вG���M�c���P��Z%�9?܂�?P����5���($:8z���˃��22,���&^F�3���E�5�s�g�.���#W��?��W����B�GO���N�e`� ��^�
� ��i �d Access to free training and consulting services through the DBE Supportive Services Center. Overview and Requirements. Once home-state DBE certified, submit the following document, fully completed and notarized, along with all required documentation identified in items 1 through 4 on the first page. Benefits of DBE Certification through TUCP Listing your business in a central DBE directory DBE Supportive Services. For PA Unified Certification Program applicants and firms only. More information about updating can be found on the DBE program page. This application must be completed, including all supporting documents. %PDF-1.6
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Does the socially and economically disadvantaged owner(s) have a personal net worth not greater than $1.32 million? The PA Unified Certification Program Annual Affidavit and PA Unified Certification Program No Change Affidavit may also be downloaded.
DBE certification is recognized by many state, regional, and local diverse, minority, and women business programs. 1Knowingly and willfully providing false information to the Federal government is a violation of 18 U.S.C.
The purpose of the Pennsylvania Unified Certification Program (PA UCP) is to provide one-stop shopping for certification as a Disadvantaged Business Enterprise (DBE)/Airport Concessionaire Disadvantaged Business Enterprise (ACDBE). Section 1001 (False Statements) and could subject you to fines, imprisonment or both. endstream
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The PA UCP makes all certification decisions on behalf of all agencies/organizations in the Commonwealth with respect to participation in the DBE Program.
You may submit the DBE Annual Update Affidavit online at the Diversity Management System.
Greater visibility to contractors and consultants looking to utilize DBE firms to meet goals on federally assisted transportation projects.
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PA UCP-Annual No Change Affidavit (Revised 11/2019) Name of DBE Firm Ow ner Name of DBE Firm Own er To request an authorized user account, please click, PA UCP & Certification Supportive Material. Or if an Airport Concessionaire, is the firm's three year average of gross receipts less than $56.42 million. Use this form going forward PA UCP and COVID-19.
PA UCP DBE/ACDBE Interstate Certification Affidavit Additional documents for currently certified DBE firms: PA UCP DBE/ACDBE Annual No Change Affidavit PA UCP DBE/ACDBE … Firms certified as DBE/ACDBE/ Both (DBE & ACDBE) with the PA UCP are eligible to participate on any Federal Aviation Administration (FAA), Federal Highway Administration (FHWA), and Federal Transit Administration (FTA) funded contracts as a DBE/ACDBE/Both (DBE & ACDBE). 309 0 obj
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